Digestive Diseases and Sciences

, Volume 28, Issue 2, pp 174–182 | Cite as

Pill-induced esophageal injury

Case reports and review of the medical literature
  • James Walter Kikendall
  • Arnold C. Friedman
  • Morakinyo Anthony Oyewole
  • David Fleischer
  • Lawrence F. Johnson
Original Articles


We report four cases of esophageal injury associated with the ingestion of commonly prescribed tablets or capsules. History and clinical characteristics of these cases suggest that the medications failed to transit the esophagus and acted locally to produce esophagitis. A search of English- and foreign-language medical journals documented 221 similar cases due to 26 different types of medication. While most of these esophageal injuries are self-limited and produce no morbidity beyond transient retrosternal pain, odynophagia, and dysphagia, major complications have occurred, such as mediastinal penetration, hemorrhage, and death. Patients should be counseled to take pills in an upright posture with liberal amounts of fluid well before retiring for the night.


Public Health Medical Journal Major Complication Esophagitis Similar Case 
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  1. 1.
    Pemberton J: Oesophageal obstruction and ulceration caused by oral potassium therapy. Br Heart J 32:267–268, 1970Google Scholar
  2. 2.
    Juncosa L: Ulcus peptico yatrogeno del esofago. Rev Esp Enferm Apar Dig 30:457–458, 1970Google Scholar
  3. 3.
    Carlborg B, Kumlien A, Olsson H: Medikamentella esofagusstrikturer. Lakartidningen 75:4609–4611, 1978Google Scholar
  4. 4.
    Giger M, Sonnenberg A, Brandli H, Singeisen M, Guller R, Blum AL: Das tetracyclin-ulkus der speiserohre. Dtsch Med Wochenschr 103:1038–1040, 1978Google Scholar
  5. 5.
    Kobler E, Buhler H, Nuesch HJ, Deyhle P: Medikamentos induzierte osophagusulzera. Dtsch Med Wochenschr 103:1035–1037, 1978Google Scholar
  6. 6.
    Kobler E, Nuesch HJ, Buhler H, Jenny S, Deyhle P: Medikamentos bedingte Osophagusulzera. Schweiz Med Wochenschr 109:1180–1182, 1979Google Scholar
  7. 7.
    Evenepoel C: Slokdarmzweren door gebruik van doxycycline. Tijdschr Gastroenterol 20:293–296, 1977Google Scholar
  8. 8.
    Meyboom RHB: Slokdarmbeschadiging door doxycycline en tetracycline. Ned Tijdschr Geneeskd 121:1770, 1977Google Scholar
  9. 9.
    Bokey L, Hugh TB: Oesophageal ulceration associated with doxycycline therapy. Med J Aust 1:236–237, 1975Google Scholar
  10. 10.
    Schneider R: Doxycycline esophageal ulcers. Am J Dig Dis 22:805–807, 1977Google Scholar
  11. 11.
    Maffioli C, Segal S, Renard A, Diot J, Segal A: Ulceres oesophagiens a la doxycycline. Nouv Presse Med 8:1264, 1979Google Scholar
  12. 12.
    Kavin H: Oesophageal ulceration due to emepronium bromide. Lancet 1:424–425, 1977Google Scholar
  13. 13.
    Aarons B, Bruns BJ: Oesophageal ulceration associated with ingestion of doxycycline. NZ Med J 91:27, 1980Google Scholar
  14. 14.
    O'Meara TF: A new endoscopic finding of tetracycline-induced esophageal ulcers. Gastrointest Endosc 26:106–107, 1980Google Scholar
  15. 15.
    Kimura K, Sakai H, Ido K, et al: Drug-induced esophageal ulcer. Nippon Shokakibyo Gakkai 75:64–70, 1978Google Scholar
  16. 16.
    Sakai H, Seki H, Yoshida Y, Shirahata T, Ido K, Kimura K: Radiological study of drug-induced esophageal ulcer. Rinsho Hoshasen 25:27–34, 1980Google Scholar
  17. 17.
    Crowson TD, Head LH, Ferrante WA: Esophageal ulcers associated with tetracycline therapy. J Am Med Assoc 235:2747–2748, 1976Google Scholar
  18. 18.
    Schmidt-Wilcke HA: Tetracyclin-ulkus der speiserohre. Dtsch Med Wochenschr 103:2053, 1978Google Scholar
  19. 19.
    Djupesland G, Rolstad EA: Etsskader i oesophagus forarsaket av medikamenter. Tidsskr Nor Laegeforen 98:696–697, 1978Google Scholar
  20. 20.
    Khera DC, Herschman BR, Sosa F: Tetracycline-induced esophageal ulcers. Postgrad Med 68:113, 115, 1980Google Scholar
  21. 21.
    Burke EL: Acute oesophageal damage from one brand of tetracycline tablets. Gastroenterology 68:1022, 1975Google Scholar
  22. 22.
    Froese EH: Oesophagitis with clindamycin. S Afr Med J 56:826, 1979Google Scholar
  23. 23.
    Sutton DR, Gosnold JK: Oesophageal ulceration due to clindamycin. Br Med J 1:1598, 1977Google Scholar
  24. 24.
    Stillman AE, Martin RJ: Tetracycline-induced esophageal ulcerations. Arch Dermatol 115:1005, 1979Google Scholar
  25. 25.
    Seaman WB: The case of the antibiotic dysphagia. Hosp Pract 14:206, 208, 1979Google Scholar
  26. 26.
    Habeshaw T, Bennett JR: Ulceration of mouth due to emepronium bromide. Lancet 2:1422, 1972Google Scholar
  27. 27.
    Bennett JR: Oesophageal ulceration due to emepronium bromide. Lancet 1:810, 1977Google Scholar
  28. 28.
    Shepperd HWH: Iatrogenic reflux oesophagitis. J Laryngol Otol 91:171–172, 1977Google Scholar
  29. 29.
    Hale JE, Barnardo DE: Ulceration of mouth due to emepronium bromide. Lancet 1:493, 1973Google Scholar
  30. 30.
    Kenwright S, Norris ADC: Oesophageal ulceration due to emepronium bromide. Lancet 1:548, 1977Google Scholar
  31. 31.
    Higson RH: Oesophagitis as a side effect of emepronium. Br Med J 2:201, 1978Google Scholar
  32. 32.
    Kunert H: Medikamentos induzierte osophagusulzera. Dtsch Med Wochenschr 103:1278, 1978Google Scholar
  33. 33.
    Hughes R: Drug-induced oesophageal injury. Br Med J 2:132, 1979Google Scholar
  34. 34.
    Cowan RE, Wright JT, Marsh F: Drug-induced oesophageal injury. Br Med J 2:132–133, 1979Google Scholar
  35. 35.
    Chapman K: Emepronium bromide and the treatment of urge incontinence. Med J Aust 1:103, 1978Google Scholar
  36. 36.
    Collins FJ, Matthews HR, Baker SE, Stakova J: Pill-induced oesophageal injury. Br Med J 1:1673–1676, 1979Google Scholar
  37. 37.
    Rose JDR, Tobin GB: Drug-induced oesophageal injury. Br Med J 1:110, 1980Google Scholar
  38. 38.
    Lind O: Medikamentidusert osofagitt. Tidsskr Nor Lageforen 98:742, 1978Google Scholar
  39. 39.
    Pahakka HJ: Drug-induced corrosive injury of the esophagus. J Laryngol Otol 92:927–931, 1978Google Scholar
  40. 40.
    Barbier P, Pringot J, Heimann R, Fiasse R, Jacobs E: Ulcerations digestives induites par le chlorure de potassium. Acta Gastroenterol Belg 39:261–274, 1976Google Scholar
  41. 41.
    Lubbe WF, Cadogan ES, Kanneineyer AHR: Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement. NZ Med J 90:377–379, 1979Google Scholar
  42. 42.
    McCall AJ: Slow-K ulceration of oesophagus with aneurysmal left atrium. Br Med J 3:230–231, 1975Google Scholar
  43. 43.
    Rosenthal T, Adar R, Militianu J, Deutsch V: Esophageal ulceration and oral potassium chloride ingestion. Chest 65:463–465, 1974Google Scholar
  44. 44.
    Howie AD, Strachan RW: Slow release potassium chloride treatment. Br Med J 2:176, 1975Google Scholar
  45. 45.
    Chesshyre MH, Braimbridge MV: Dysphagia due to left atrial enlargement after mitral Starr valve replacement. Br Heart J 33:799–802, 1971Google Scholar
  46. 46.
    Peters JL: Benign oesophageal stricture following oral potassium chloride therapy. Br J Surg 63:698–699, 1976Google Scholar
  47. 47.
    Whitney B, Croxon R: Dysphagia caused by cardiac enlargement. Clin Radiol 23:147–152, 1972Google Scholar
  48. 48.
    Riker J, Swanson M, Schweigert B: Esophageal ulceration caused by wax-matrix potassium chloride. West J Med 128:542–543, 1978Google Scholar
  49. 49.
    Learmonth I, Weaver PC: Potassium stricture of the upper alimentary tract. Lancet 1:251–252, 1976Google Scholar
  50. 50.
    Abbarah TR, Fredell JE, Ellenz GB: Ulceration by oral ferrous sulfate. J Am Med Assoc 236:2320, 1976Google Scholar
  51. 51.
    Teplick JG, Teplick SK, Ominsky SH, Haskin ME: Esophagitis caused by oral medication. Radiology 134:23–25, 1980Google Scholar
  52. 52.
    Bohane TD, Perrault J, Fowler RS: Oesophagitis and oesophageal obstruction from quinidine tablets in association with left atrial enlargement. Aust Paediatr J 14:191–192, 1978Google Scholar
  53. 53.
    Mason SJ, O'Meara TF: Drug-induced esophagitis. J Clin Gastroenterol 3:115–120, 1981Google Scholar
  54. 54.
    Gardies A, Gevaudan J, LeRoux C, Cornet C, Warnet-Dubosca J, Viguie R: Ulcere iatrogene de l'oesophage. Nouv Presse Med 7:1032, 1978Google Scholar
  55. 55.
    Agdal N: Mediciniducerede esophagusskader. Ugeskr Laeger 141:3019–3021, 1979Google Scholar
  56. 56.
    Drug Experience Report. Spontaneous Reporting Program (1969–1980). Division of Drug Experience (HFD-210). Food and Drug Administration, 5600 Fishers Lane, Rockville, Maryland 20875Google Scholar
  57. 57.
    Williams JG: Drug-induced oesophageal injury. Br Med J 2:273, 1979Google Scholar
  58. 58.
    Walta DC, Giddens JD, Johnson LF, Kelley JL, Waugh DF: Localized proximal esophagitis secondary to ascorbic acid ingestion and esophageal motor disorder. Gastroenterology 70:766–769, 1976Google Scholar
  59. 59.
    Lodge KV: The pathology of nonspecific oesophagitis. J Pathol Bacteriol 69:17–24, 1955Google Scholar
  60. 60.
    Hogan WJ, Viegos de Andriade SR, Winship DH: Ethanol-induced acute esophageal motor dysfunction. J Appl Physiol 32:755–760, 1972Google Scholar
  61. 61.
    Mayer EM, Grabowski CJ, Fisher RS: Effects of graded doses of alcohol upon esophageal motor function. Gastroenterology 75:1133–1136, 1978Google Scholar
  62. 62.
    Smith VM: Association of aspirin ingestion with symptomatic hiatus hernia. South Med J 71 (Suppl 1):45–47, 1978Google Scholar
  63. 63.
    Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer C, Petrie DJ: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980Google Scholar
  64. 64.
    Johnson LF, Rinaldo JA, Spiro HM: Endoscopic evaluation of the esophagus.In National Commission on Digestive Diseases. Report to the Congress of the United States. Vol. 4, Part 3: Report of the work groups on health care delivery. U.S. Department of Health, Education and Welfare Publication No. (NIH) 79-1886, 1979, p 373Google Scholar
  65. 65.
    Humphries TJ, Castell DO: Pressure profile of esophageal peristalsis in normal humans as measured by direct intraesophageal transducers. Am J Dig Dis 22:641–645, 1977Google Scholar
  66. 66.
    Applegate GR, Malmud LS, Rock E, Reilley JR, Fisher RS: “It's a hard pill to swallow” or “Don't take it lying down.” Gastroenterology 78:1132, 1980Google Scholar
  67. 67.
    Evans KT, Roberts GM: Where do all the tablets go? Lancet 2:1237–1239, 1976Google Scholar
  68. 68.
    Schneyer LH, Pigman W, Hanahan L, Gilmore RW: Rate of flow of human parotid, sublingual and submaxillary secretions during sleep. J Dent Res 35:109–114, 1956Google Scholar
  69. 69.
    Pilbrant A: Ulceration due to emepronium bromide tablets. Lancet 1:749, 1977Google Scholar
  70. 70.
    Lauder AD: Cetiprin and oesophageal ulceration. Br Med J 2:211, 1979Google Scholar
  71. 71.
    Carlborg B: Biverkningar vid accidentell losning av lakemedel i esofagus och bronker. Lakartidningen 73:4201–4204, 1976Google Scholar
  72. 72.
    Eastwood GL, Castell DO, Higgs RH: Experimental esophagitis in cats impairs lower esophageal sphincter pressure. Gastroenterology 69:146–153, 1975Google Scholar
  73. 73.
    Phaosawasdi K, Malmud LS, Tolin RD, Steltzer F, Applegate G, Fisher RS: Cholinergic effects on esophageal transit and clearance. Gastroenterology 81:915–920, 1981Google Scholar
  74. 74.
    Burrington JD: Clinitest burns of the esophagus. Ann Thorac Surg 20:400–404, 1975Google Scholar
  75. 75.
    Volpicelli NA, Bedine MS, Hendrix TR: Absence of acid sensitivity in patients with benign peptic esophageal strictures. Gastroenterology 68:A-150/1007, 1975Google Scholar

Copyright information

© Digestive Disease Systems, Inc. 1983

Authors and Affiliations

  • James Walter Kikendall
    • 1
    • 2
    • 3
  • Arnold C. Friedman
    • 1
    • 2
    • 3
  • Morakinyo Anthony Oyewole
    • 1
    • 2
    • 3
  • David Fleischer
    • 1
    • 2
    • 3
  • Lawrence F. Johnson
    • 1
    • 2
    • 3
  1. 1.Gastroenterology and Radiology DivisionsWalter Reed Army Medical CenterWashington, D.C.
  2. 2.the Uniformed Services University of the Health SciencesWashington, D.C.
  3. 3.the Gastroenterology/Hepatology SectionVeterans Administration Medical CenterWashington, D.C.

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